The University of Pennsylvania's Health Care Systems Department at the Wharton School, together with the Division of General Internal Medicine and the Leonard Davis Institute of Health Economics request five additional years of funding to support the training of two post-doctoral and eight pre-doctoral students per year in the PhD program in Health Services Research at the University of Pennsylvania. The applicant seeks support for two to three years for each student. Funding for the remainder of their training (a total of four to five years) will come from other sources. The original NRSA grant, awarded in 1986, was instrumental in helping the University establish an educational program which has become one of the nation's leading PhD programs in Health Services Research. This program combines intensive graduate-level training in several traditional academic disciplines with advanced study in health services research, cross-disciplinary coursework, research experience with mentors, and collaboration with faculty and fellows. The program curriculum and the research interests of the faculty are highly congruent with the overall goals of the NRSA program and with the priority areas of AHRQ and the types of research for which training is sought. Students have been trained in: 1) health economics; 2) health systems management; 3) outcomes measurement; 4) quality measurement and quality incentives; 5) biostatistics; 6) epidemiology; 7) decision analysis; 8) cost-benefit and cost-effectiveness analysis; 9) analysis of quality and cost tradeoffs or complementarities; 10) health outcomes and programs for underserved populations; 11) insurance economics; and a host of other health services issues. In all these areas, the University of Pennsylvania has excellent faculty with well-established research records and on-going research programs. Graduates of the University's NRSA program have gone on to careers in academia, highly reputed research institutes, and research functions with government. AHRQ/NRSA funding to support tuition and stipends for students is essential to the maintenance of this program of excellence. The program builds on the close teaching and research collaboration between the Wharton School, the School of Medicine, the Department of Economics, the Department of Biostatistics and Epidemiology, the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, and the Center for Outcomes Research at Children's Hospital. The strong connections between the Medical School and the Wharton School make this program highly attractive to physicians as well as to non-physicians. The program incorporates plans to intensify efforts to recruit minority students through several channels, including closer collaboration with Penn's Center for Excellence for Diversity in Health Education and Research, a HRSA-funded program promoting research in minority issues, minority student and faculty recruitment and retention, and advancing leadership roles of minority faculty.